Fight to close trauma center a 'turf battle,' hospital lawyer says

Published: Friday, February 15, 2013 at 7:40 p.m.

Last Modified: Friday, February 15, 2013 at 7:40 p.m.

Ocala Regional Medical Center officials said Friday that the Florida Department of Health's decision this week to close another Hospital Corporation of America trauma center does not foretell the future of their Ocala trauma facility.

Orange Park Medical Center was, before its closing Thursday, on temporary provisional status, as is the case with Ocala's HCA trauma Center.

The decision to close Orange Park's trauma center Thursday occurred the same day as a Leon County judge heard arguments about whether the Ocala trauma center, which opened in December, should have been allowed to open at all by the DOH.

Ocala Regional is owned by Ocala Health System, which is a subsidiary of HCA.

HCA attorney Steve Ecenia, a lawyer who helped set up Marion County's sole trauma center — as well as the one at Orange Park Medical Center near Jacksonville — acknowledged Friday that the Ocala facility debuted months before its scheduled April opening.

By opening early, it received its provisional operating permit just before the DOH placed a moratorium on new trauma applications. The DOH imposed that freeze last year following a recent appeals court decision ruling that DOH's trauma regulatory rules were inadequate.

Munroe Regional Medical Center, Shands at the University of Florida and Shands Jacksonville Medical Center are asking the Circuit Court in Leon County to overturn DOH's decision that allowed Ocala Regional to open the trauma unit.

But Ecenia said the Orange Park trauma center and the one in Ocala "are completely different."

"They (Orange Park) were on a much different time frame," he said.

Typically, the DOH inspects trauma centers after they've been operating under their provisional license for about a year. Orange Park's trauma center had been operational since 2011 under its provisional status. Ocala Regional's facility has been operating only two months.

As for Ocala Regional's early December 2012 opening, Ecenia said only, "If we didn't meet substantial compliance to be provisionally approved, they (DOH) wouldn't have approved us."

"Orange Park is a different place, a different group of people," he said.

"I don't really have concerns that we're going to have a problem in Ocala," Ecenia said.

Ecenia said he still has not seen the DOH's specific concerns with the Orange Park facility.

On its web site, the DOH described its concerns only in generalities, citing the center's emergency department, acute rehabilitative services, psychological support system and quality management.

The Star-Banner asked the DOH Friday for a copy of its original letter to Orange Park's trauma center expressing standards deficiencies and Orange park's response. DOH spokeswoman Ashley Carr responded that the DOH would not make the letter public because it was exempt under Florida's public records laws.

Meanwhile, Ecenia points to HCA's Blake Medical Center in Manatee County and Regional Medical Center Bayonet Point in Pasco County, both of which recently finished their provisional approval status for their trauma centers and now enjoy a more permanent operating status.

Those two facilities' trauma centers were also challenged beginning in 2011 by Shands Jacksonville, Tampa General Hospital, St. Joseph's Hospital in Tampa and Bayfront Medical Center in St. Petersburg. Those four hospitals already have trauma centers of their own.

The dispute over Ocala Regional's trauma center is similar to the challenges faced by other HCA trauma centers.

In 2004 the Florida Legislature told the Department of Health to update its rules concerning trauma centers. The rules had not changed since 1992.

But the department did not act. And in September 2011 an administrative law judge found that the department rules for determining the location and need for trauma centers were invalid.

In November the 1st District Court of Appeal upheld that ruling. But the Department of Health granted Ocala Regional its provisional status before the appellate court's decision took effect — allowing the new trauma center to slip in just under the legal wire.

That DOH move is now being challenged by Munroe and Shands, with those hospitals saying the DOH didn't have the authority to grant Ocala Regional's request to open a trauma center. They also said that no trauma center was needed here.

Meanwhile, Munroe had previously also asked DOH for its own trauma center, but was denied, failing to make the DOH deadline. Shands at UF officials complained that the Ocala trauma center would take a third of its trauma business away and interfere with its ability to get grants.

Meanwhile, Orange Park Medical Center issued a statement that said it plans to appeal the decision, but will suspend its trauma-center operations pending the appeal.

In a Leon County courtroom on Thursday, Circuit Judge Terry Lewis listened to arguments about whether DOH improperly gave provisional approval to open Ocala Regional's trauma center Medical Center.

Lewis listened to arguments for more than three hours about issues such as how the department has carried out laws about the trauma system. Attorneys for Munroe and the Shands hospitals argued that the department overstepped its legal authority to approve the Ocala Regional trauma center, a position that stems at least in part from court fights during the past two years with other hospitals.

"We're here because they are acting without authority," said Seann Frazier, an attorney for the Shands hospitals.

But attorneys for the department and Ocala Regional said the agency followed state law in approving the trauma center. J. Stephen Menton, an attorney for Ocala Regional, told Lewis that the case is motivated by Shands trying to retain control of the trauma market for patients who come from nearby Marion County.

<p>Ocala Regional Medical Center officials said Friday that the Florida Department of Health's decision this week to close another Hospital Corporation of America trauma center does not foretell the future of their Ocala trauma facility.</p><p>Orange Park Medical Center was, before its closing Thursday, on temporary provisional status, as is the case with Ocala's HCA trauma Center.</p><p>The decision to close Orange Park's trauma center Thursday occurred the same day as a Leon County judge heard arguments about whether the Ocala trauma center, which opened in December, should have been allowed to open at all by the DOH.</p><p>Ocala Regional is owned by Ocala Health System, which is a subsidiary of HCA.</p><p>HCA attorney Steve Ecenia, a lawyer who helped set up Marion County's sole trauma center — as well as the one at Orange Park Medical Center near Jacksonville — acknowledged Friday that the Ocala facility debuted months before its scheduled April opening.</p><p>By opening early, it received its provisional operating permit just before the DOH placed a moratorium on new trauma applications. The DOH imposed that freeze last year following a recent appeals court decision ruling that DOH's trauma regulatory rules were inadequate.</p><p>Munroe Regional Medical Center, Shands at the University of Florida and Shands Jacksonville Medical Center are asking the Circuit Court in Leon County to overturn DOH's decision that allowed Ocala Regional to open the trauma unit.</p><p>But Ecenia said the Orange Park trauma center and the one in Ocala "are completely different."</p><p>"They (Orange Park) were on a much different time frame," he said.</p><p>Typically, the DOH inspects trauma centers after they've been operating under their provisional license for about a year. Orange Park's trauma center had been operational since 2011 under its provisional status. Ocala Regional's facility has been operating only two months.</p><p>As for Ocala Regional's early December 2012 opening, Ecenia said only, "If we didn't meet substantial compliance to be provisionally approved, they (DOH) wouldn't have approved us."</p><p>"Orange Park is a different place, a different group of people," he said.</p><p>"I don't really have concerns that we're going to have a problem in Ocala," Ecenia said.</p><p>Ecenia said he still has not seen the DOH's specific concerns with the Orange Park facility.</p><p>On its web site, the DOH described its concerns only in generalities, citing the center's emergency department, acute rehabilitative services, psychological support system and quality management.</p><p>The Star-Banner asked the DOH Friday for a copy of its original letter to Orange Park's trauma center expressing standards deficiencies and Orange park's response. DOH spokeswoman Ashley Carr responded that the DOH would not make the letter public because it was exempt under Florida's public records laws.</p><p>Meanwhile, Ecenia points to HCA's Blake Medical Center in Manatee County and Regional Medical Center Bayonet Point in Pasco County, both of which recently finished their provisional approval status for their trauma centers and now enjoy a more permanent operating status.</p><p>Those two facilities' trauma centers were also challenged beginning in 2011 by Shands Jacksonville, Tampa General Hospital, St. Joseph's Hospital in Tampa and Bayfront Medical Center in St. Petersburg. Those four hospitals already have trauma centers of their own.</p><p>The dispute over Ocala Regional's trauma center is similar to the challenges faced by other HCA trauma centers.</p><p>In 2004 the Florida Legislature told the Department of Health to update its rules concerning trauma centers. The rules had not changed since 1992.</p><p>But the department did not act. And in September 2011 an administrative law judge found that the department rules for determining the location and need for trauma centers were invalid.</p><p>In November the 1st District Court of Appeal upheld that ruling. But the Department of Health granted Ocala Regional its provisional status before the appellate court's decision took effect — allowing the new trauma center to slip in just under the legal wire.</p><p>That DOH move is now being challenged by Munroe and Shands, with those hospitals saying the DOH didn't have the authority to grant Ocala Regional's request to open a trauma center. They also said that no trauma center was needed here.</p><p>Meanwhile, Munroe had previously also asked DOH for its own trauma center, but was denied, failing to make the DOH deadline. Shands at UF officials complained that the Ocala trauma center would take a third of its trauma business away and interfere with its ability to get grants.</p><p>Meanwhile, Orange Park Medical Center issued a statement that said it plans to appeal the decision, but will suspend its trauma-center operations pending the appeal.</p><p>In a Leon County courtroom on Thursday, Circuit Judge Terry Lewis listened to arguments about whether DOH improperly gave provisional approval to open Ocala Regional's trauma center Medical Center.</p><p>Lewis listened to arguments for more than three hours about issues such as how the department has carried out laws about the trauma system. Attorneys for Munroe and the Shands hospitals argued that the department overstepped its legal authority to approve the Ocala Regional trauma center, a position that stems at least in part from court fights during the past two years with other hospitals.</p><p>"We're here because they are acting without authority," said Seann Frazier, an attorney for the Shands hospitals.</p><p>But attorneys for the department and Ocala Regional said the agency followed state law in approving the trauma center. J. Stephen Menton, an attorney for Ocala Regional, told Lewis that the case is motivated by Shands trying to retain control of the trauma market for patients who come from nearby Marion County.</p><p>"What we've got here is a turf battle," Menton said. "It's as simple as that."</p><p><I>Contact Fred Hiers at fred.hiers@starbanner.com or 867-4157.</i></p>